Are oncologists right to hail a new era in which cancer is a chronic disease
rather than a death sentence?

This is not the end, warned Winston Churchill in 1942. “It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” How apt his words seem this morning, on World Cancer Day, when applied to our long battle against the disease. There is, indeed, new cause for hope. Last week Prof Alan Ashworth, chief executive of the Institute of Cancer Research, launched a £3 million DNA database, the Tumour Profiling Unit, to identify genes responsible for cancers that will become targets for new therapies.

This means patients will have their tumour’s DNA decoded, and then be matched precisely with the right drugs to keep the disease at bay. Prof Ashworth explained that this is a crucial step towards transforming some types of cancer into a manageable disease rather than a death sentence. “We should be aspiring to cure cancer, but for people with advanced disease, it will be a question of managing them better so they survive for much longer, turning cancer into a chronic disease.”

A report by the King’s Fund in 2011 claimed that the rate of overall improvement in cancer survival accelerated between 2004 and 2007, possibly as a result of the NHS Cancer Plan, published in 2000, under Prof Sir Mike Richards, National Clinical Director for Cancer. This strategy for investment and reform across the NHS aimed to give cancer services high priority, by improving prevention, promoting early detection through screening, and guaranteeing high-quality treatment throughout the country. It set new national and local targets (including those for the reduction of smoking and the reduction of waiting times).

Macmillan Cancer Support figures showed in 2011 that, overall, people with cancer in Britain are living six times longer after diagnosis than 40 years ago – because of earlier diagnosis, improvements in surgery and advances in chemotherapy, radiotherapy and other drugs. Yet much remains to be done. Survival rates differ significantly: high for breast and skin cancer, still low for lung and pancreatic. “I am always impatient,” says Prof Richards, “for more improvements: shorter waiting times, better quality treatments. But overall we are making progress.”

He identifies late diagnosis as an ongoing issue. “For example, fewer people are smoking so fewer people are getting lung cancer, but those who do are not getting spotted early enough.”

His anxiety is backed up by a King’s College London study released last week suggesting that Britons are as aware of cancer symptoms as other nationalities, but less likely to act on them.

Prof Gordon McVie, senior consultant at the European Institute of Oncology, in Milan, says: “The number of cases should be falling anyway, given how much we know about lifestyle factors – such as smoking or obesity – triggering cancer. The public are more aware, but this hasn’t always translated into changed behaviour.”

The state of the world’s finances matter more than ever. Large pharmaceutical companies are tightening their belts due to the global downturn, causing “a bottleneck in production of new treatments”, warns Prof McVie. But he adds: “There is no question that we are getting on top of cancer.”

Prof Richards agrees. “Defeating cancer has always been about multiple small games, from screening to awareness – not finding one big blockbuster drug.”

Here we examine some of the most common cancers, their survival rates and the promise held out by future therapies.

LUNG CANCER

Affected About 42,000 cases are diagnosed annually, with some 35,000 deaths every year. Lung cancer is the most common cause of cancer death and the number of women living with lung cancer in the UK is set to rise 35 times faster than for men within the next 30 years, warns Macmillan Cancer Support. (Women took up smoking later and more slowly than men.)

Survival About 30 per cent survive for at least one year after diagnosis, but less than 10 per cent survive for five years. About 5 per cent will survive longer than 10 years.

Has a gene been found? At least one faulty lung cancer gene is likely to be hereditary; if you have a first-degree relative with lung cancer your risk is increased by 51 per cent, regardless of smoking habits. That said, the chief cause of lung cancer is smoking (90 per cent). The tumour-suppressor gene P53 is damaged in many types of cancer, including lung cancer.

Promising therapies The focus is earlier diagnosis through the screening of chemicals detected in blood and sputum. Patients in trials are being offered a battery of drugs from new biological therapies, monoclonal antibodies (those made by identical immune cells), immunotherapies (which use the body’s defence system to attack cancer cells) and growth-suppressing drugs.

One trial is looking at BKM120, a type of biological therapy that blocks the actions of proteins called P13K; these send signals telling cancer cells to grow (the P13 pathway).

The future French researchers announced last year that the number of non-smokers with a type called non-small cell lung cancer is increasing, and called for more investigation into diesel fumes, which the WHO has now classified as carcinogenic.

BOWEL CANCER

Affected More than 40,000 are diagnosed with bowel cancer, the second most common cause of cancer death in the UK (about 16,000 deaths per year). Almost two thirds (64 per cent) of all bowel cancers are of the colon, and over one third (36 per cent) are of the rectum (including the anus).

Survival More than 90 per cent survive after five years if diagnosed at an early stage. However, only 9 per cent of patients in the UK are diagnosed early, when cancer is still contained in the bowel. Once the cancer spreads to lymph nodes and/or beyond, about 47 per cent survive more than five years. Survival rates after 10 years are unavailable.

Has a relevant gene been found? Last year, British researchers discovered two genes, passed from parent to child, that greatly increase the risk of a tumour forming when faulty.

Promising therapies From stents in the bowel to relieve blockages, to robotic surgery and even fish oil supplements. Exciting surgical trials are also under way. New ways of combining chemotherapy and existing drugs are being tested in trials.

There are moves to make radiotherapy more effective, too, including administering it during surgery and using selective internal radiation therapy for secondary bowel cancer.

The future An Italian breath test, which looks for exhaled chemicals linked to tumour activity, was highly successful in trials. Current screenings look for signs of blood in the faeces, but false positives are common. University of Colorado researchers have found grape seed extract can inhibit the growth of colorectal cancer cells.

BREAST CANCER

Affected 550,000 in the UK overall; every year, nearly 55,000 are diagnosed. About 36,000 have secondary breast cancer (ie, the disease has spread).

Survival Some 82 per cent survive beyond five years (including those whose breast cancer has spread but are still alive after five years). More than 75 per cent survive beyond 10 years.

Has a relevant gene been found? Five per cent of those diagnosed with breast cancer have genes BRCA1 or BRCA2. These genes increase the risk five-fold.

Promising therapies Trials are under way to see if keyhole surgery is a better procedure than lumpectomies or mastectomies (reports last week suggest survival is greater for women who undergo lumpectomies).

Tumour genes are being examined post-surgery to help pinpoint the best drug regimes, and the efficacy of several types of chemotherapy, including one made from sea sponge, is being studied. 3D and infrared scanning are improving the way doctors examine breast tumours.

The future A vaccine for ductal carcinoma in situ (DCIS), the most common non-invasive form of the disease, is in early trials at the University of Pennsylvania. After four years, 85 per cent of women had protection from the disease. Other studies are looking at the prophylactic use of the drug tamoxifen in high-risk women.

SKIN CANCER

Affected12,800 are diagnosed with malignant melanoma annually, more than four times as many as 30 years ago.

Survival For women, there is a 91.6 per cent survival rate after five years; for men that slips to 83.6 per cent. The difference may be due to women being diagnosed earlier. After 10 years, women have an 88 per cent survival rate and men, 76.7 per cent.

Has a gene been found? A 2009 study from King’s College London suggests that two genes that influence the number of moles people develop may help identify those at high risk of malignant melanoma. Tim Spector, professor of genetic epidemiology at King’s, and one of its authors, says: “The number of moles you have is one of the strongest risk factors for melanoma – stronger even than sunshine.”

Promising therapies Numerous trials are under way examining how immunotherapies and chemotherapies can control the disease. This is the key to future treatments because melanoma cannot always be completely removed by surgery.

One trial is looking at whether SCIB1, a liquid that contains small pieces of DNA, can activate immune system cells. Other tests are exploring ways to improve screening and testing for earlier diagnosis.

The future Research from Western Ontario University has identified a potential new target, a channel-forming protein called Pannexin (Panx1) found in normal levels on the surface of healthy skin cells. In melanoma, Panx1 is overproduced to a pathological level, possibly causing or allowing it to become aggressive.

Researchers believe that a drug to target that protein could reduce its production or block its function, potentially slowing down or stopping the cancer altogether.

PROSTATE CANCER

Affected 250,000 men have prostate cancer in the UK, with more than 40,000 diagnosed every year.

Survival More than 81 per cent survive for five years or more, says Prostate Cancer UK, rising to 98.6 per cent if the cancer has not spread outside.

Has a relevant gene been found? It remains unclear how certain genes affect the development of prostate cancer.

Promising therapies The hormonal drug abiraterone extends the lives of men with advanced cancer; others may be available next year. High-frequency ultrasound treatment is being tested to see if it can delay spread, as are chemotherapy and immunotherapies.

The future Research focuses on improved diagnostic tests to better identify which prostate cancers are aggressive and need treatment and how to reduce the serious side-effects of treatments.

CHILDHOOD CANCERS

Affected About 1,600 children up to the age of 15 are diagnosed each year (only one in every 500 under 15 develops a cancer). Most common is acute lymphoblastic leukaemia, with about 300 cases a year, followed by cancers of the brain and spine.

Survival rates In the Sixties, only 30 per cent of children were successfully treated. But over the past 40 years, treatment has improved greatly. Now almost eight out of every 10 children diagnosed with cancer will live for at least five years, and the vast majority of those who survive five years will be cured. Hodgkin lymphoma and retinoblastoma are curable in more than nine out of 10 children.

Have relevant genes been found? Certain inherited conditions increase a child’s risk of developing some types of cancers, says Cancer Research UK. For example, children with Down’s syndrome are 10 to 20 times more likely to get leukaemia than other children.

Two genetic mutations responsible for up to 40 per cent of glioblastomas in children were found by an international team based in Canada last year. The discovery of the mutations may have significant implications for the treatment of other cancers, reported Nature.

Promising therapies The Cancer Research UK Children’s Cancer Trials Team at the University of Birmingham, created two years ago, is central to the development of treatments in the UK; diseases under study include cancer of the brain stem, classic Hodgkins, high risk neuroblastoma, Wilms’ tumours and leukaemia. About 60 per cent of children with cancer are taking part in trials.

The future A Seattle paediatric team is working on a method of reprogramming the body’s own immune system to kill cancer, genetically re‑engineering an individual’s T cells, offering a future of cancer cures without the side effects of radiation and chemotherapy, with implications for virtually every type of childhood cancer.

Another clue may be in breastfeeding: epidemiological research in Texas has found the risk for developing acute lymphoblastic leukaemia increases the longer a baby is fed formula milk, and solid foods delayed — possibly due to the child not gathering immune factors from the mother.

Rates per 100,000

UK cancer rates per 100,000 compared with other developed countries. With 266.9 cases per 100,000, the UK has the 22nd highest cancer rate in the world.